Prevalence of priapism and its awareness amongst male homozygous sickle cell patients in Lagos

Background. Priapism is a pathological condition of penile erection that persists beyond, or is unrelated to, sexual stimulation. Impotence and infertility are major problems in male sickle cell disease patients, and priapism has been implicated as a cause of impotence and infertility. The aim of this study is to determine priapism prevalence and assess the knowledge of male homozygous male patients about it in Lagos, Nigeria. Methods. A cross-sectional study was conducted amongst male homozygous sickle cell disease patients of Lagos State University Teaching Hospital. Pretested questionnaires were distributed to determine the prevalence and assess their knowledge on priapism. Data were analyzed using SPSS version 16.0. Results. A total of 114 consenting subjects filled the questionnaires, 85 of 114 (74.6%) had not heard about priapism before this study. A total of 77 of 114 (67.5%) did not know that they are at risk of priapism. Whilst 84 of 114 (73.7%) were not aware that priapism is a complication of SCD. The majority, 94 of 114 (82.5%), were not aware that priapism could cause impotence. Conclusion. There is a need to create more awareness about this complication amongst sickle cell disease patients in order to stem the incidence of impotence and infertility amongst them

Assessing geographical distribution and accessibility of emergency obstetric care in sub-Saharan Africa: a systematic review

Background: In sub-Saharan Africa (SSA), over 200 000 women (66% of global figures) die annually due to complications of pregnancy and child-birth. Many of these deaths are preventable, especially if women have access to timely emergency obstetric care (EmOC). With poor roads and difficult topography in the region, access can be impeded. Based on United Nations EmOC assessment guidelines, minimum acceptable levels for geographical distribution of EmOC facilities have been defined (EmOC Indicator 2). We aimed to critically assess studies published in the peer-review literature that assessed EmOC geographical distribution and accessibility in SSA. METHODS: Two reviewers systematically searched multiple databases for articles published between January 2009 and June 2018. Both screened and selected studies based on the set inclusion criteria. Following quality assessments, data on study characteristics, process of data collection and analysis and findings reported were extracted. Extracted data were synthesised and presented in tables and charts. Narrative synthesis was used to summarise reported findings. RESULTS: 15 studies met the inclusion criteria, with varying assessed quality: high (7 studies), medium (4 studies) and low (4 studies). 8 studies were conducted at a national level while 7 were sub-national. 8 studies focused on assessing Indicator 2, while the others assessed multiple EmOC indicators. Only about half of the studies presented details of analysis for assessing geographical distribution, provided a map and interpreted their findings. Similarly, half of the studies used geographic information systems (GIS) for analyses. Of these, GIS was used to map EmOC facilities or relate facility numbers to 500 000 population (3), estimate straight-line distances between facilities and residences of women (2) and model travel scenarios (3). EmOC facilities in SSA are concentrated in capitals, central and urban areas and at least a third of women in the region cannot reach their nearest EmOC facility within the recommended two-hour time-frame. CONCLUSIONS: There is a limited number of studies that have assessed EmOC geographical distribution in SSA. When available, completeness and quality of analysis are questionable. Comprehensive assessments need to maximise recent advancements in mobile and GIS open-source technology to provide more realistic representation of EmOC access for service planners and policy-makers. PROSPERO REGISTRATION: CRD42018099882

Breastfeeding policy and practices at the general paediatric outpatient clinic of a teaching hospital in Lagos, Nigeria

BACKGROUND: Hospitals have a role to play in supporting, protecting and promoting breastfeeding. The aim of this study was to describe hospital breastfeeding policy and practices and breastfeeding rates among mothers attending General Paediatric Outpatient Clinic at a tertiary hospital in Lagos, Nigeria. METHODS: This was a cross-sectional study involving paediatric nurses and doctors, as well as the mothers who brought their child to the General Paediatric Outpatient Clinic. Two sets of questionnaires, different in content, were administered to doctors and nurses, and to mothers of children aged 6-24 months, to assess hospital policy and breastfeeding rates, respectively. Stepwise multiple logistic regression analysis was used to examine factors associated with duration of breastfeeding. RESULTS: Although the hospital had a written breastfeeding policy copies of the policy were not clearly displayed in any of the units in the Paediatric department. Almost half the staff (48%; 60/125) were not aware of the policy. The hospital had no breastfeeding support group. Nearly three quarters (92/125) of the staff had received lactation management training. 36% (112/311) of mothers exclusively breastfed for six months, 42% (129/311) had stopped breastfeeding at the time of the survey. 67% (207/311) of babies were given infant formula, 85% (175/207) before 6 months. Women who had antenatal care in private hospitals and were Christian were more likely to breastfeed exclusively for 6 months. Low maternal education was the only factor associated with breastfeeding longer than 12 months. CONCLUSION: Breastfeeding practices and policy implementation at this outpatient clinic were suboptimal. We have identified a need for interventions to increase knowledge of the benefits of breastfeeding and to provide support for its longer term duration. We suggest that BFHI be considered across all facilities concerned with infant and early child health to disseminate appropriate information and promote an increase in exclusive breastfeeding for six months as well as the duration of breastfeeding

Multi-stakeholder perspectives on access, availability and utilization of emergency obstetric care services in Lagos, Nigeria: A mixed-methods study

Globally, Nigeria is the second most unsafe country to be pregnant, with Lagos, its economic nerve center having disproportionately higher maternal deaths than the national average. Emergency obstetric care (EmOC) is effective in reducing pregnancyrelated morbidities and mortalities. This mixed-methods study quantitatively assessed women's satisfaction with EmOC received and qualitatively engaged multiple key stakeholders to better understand issues around EmOC access, availability and utilization in Lagos. Qualitative interviews revealed that regarding access, while government opined that EmOC facilities have been strategically built across Lagos, women flagged issues with difficulty in access, compounded by perceived high EmOC cost. For availability, though health workers were judged competent, they appeared insufficient, overworked and felt poorly remunerated. Infrastructure was considered inadequate and paucity of blood and blood products remained commonplace. Although pregnant women positively rated the clinical aspects of care, as confirmed by the survey, satisfaction gaps remained in the areas of service delivery, care organization and responsiveness. These areas of discordance offer insight to opportunities for improvements, which would ensure that every woman can access and use quality EmOC that is sufficiently available

Contraceptive use and fertility control in rural and urban communities of Lagos Nigeria

BACKGROUND: It is predicted that the population of sub-Saharan Africa will be thrice its size by the end of the 21st century. Our study compared patterns, incentives and disincentives for the uptake of contraceptives in rural and urban communities of Lagos, Nigeria. MATERIALS AND METHODS: This is a population-based cross-sectional study on 1445 women of reproductive ages 15-49 years using a cluster sampling technique and a pre-tested, interviewer-administered electronic questionnaire in 2020. Data were analysed using the Statistical Package for the Social Sciences (SPSS) software version 26.0 and ethical approval was obtained for the study. RESULTS: About 32.4% of the respondents were rural dwellers and 67.6% were urban residents. The overall mean age was 31.7 ± 7.8 years. In terms of pattern, slightly over half (53.3%) of all respondents had ever used family planning (FP), including modern contraceptives and slightly less than a third (30.8%) currently use FP methods in both rural and urban communities, respectively. Predominant disincentives for non-use of FP include a desire to retain fertility, lack of further need, unbearable side effects and lack of spousal support. The odds of being an urban dweller currently using a method of contraceptive method is 4.169 times higher for earners above ₦60,000, which is twice the minimum wage compared to those without income (adjusted odd's ratio: 4.169, 95% confidence interval: 1.395-12.462). CONCLUSION: Sustained effort is required to improve contraceptive uptake, FP service delivery and demand satisfaction for modern contraceptives to enable the achievement of demographic dividends and gains

Assessing emergency obstetric care provision in low- and middle-income countries: a systematic review of the application of global guidelines

Background Lack of timely and quality emergency obstetric care (EmOC) has contributed significantly to maternal morbidity and mortality, particularly in low- and middle-income countries (LMICs). Since 2009, the global guideline, referred to as the ‘handbook’, has been used to monitor availability, utilization, and quality of EmOC. Objective To assess application and explore experiences of researchers in LMICs in assessing EmOC. Design Multiple databases of peer-reviewed literature were systematically reviewed on EmOC assessments in LMICs, since 2009. Following set criteria, we included articles, assessed for quality based on a newly developed checklist, and extracted data using a pre-designed extraction tool. We used thematic summaries to condense our findings and mapped patterns that we observed. To analyze experiences and recommendations for improved EmOC assessments, we took a deductive approach for the framework synthesis. Results Twenty-seven studies met our inclusion criteria, with 17 judged as high quality. The highest publication frequency was observed in 2015. Most assessments were conducted in Nigeria and Tanzania (four studies each) and Bangladesh and Ghana (three each). Most studies (17) were done at subnational levels with 23 studies using the ‘handbook’ alone, whereas the others combined the ‘handbook’ with other frameworks. Seventeen studies conducted facility-based surveys, whereas others used mixed methods. For different reasons, intrapartum and very early neonatal death rate and proportion of deaths due to indirect causes in EmOC facilities were the least reported indicators. Key emerging themes indicate that data quality for EmOC assessments can be improved, indicators should be refined, a holistic approach is required for EmOC assessments, and assessments should be conducted as routine processes. Conclusions There is clear justification to review how EmOC assessments are being conducted. Synergy between researchers, EmOC program managers, and other key stakeholders would be critical for improved assessments, which would contribute to increased accountability and ultimately service provision

Assessing emergency obstetric care provision in low- and middle-income countries: a systematic review of the application of global guidelines

BACKGROUND: Lack of timely and quality emergency obstetric care (EmOC) has contributed significantly to maternal morbidity and mortality, particularly in low- and middle-income countries (LMICs). Since 2009, the global guideline, referred to as the 'handbook', has been used to monitor availability, utilization, and quality of EmOC. OBJECTIVE: To assess application and explore experiences of researchers in LMICs in assessing EmOC. DESIGN: Multiple databases of peer-reviewed literature were systematically reviewed on EmOC assessments in LMICs, since 2009. Following set criteria, we included articles, assessed for quality based on a newly developed checklist, and extracted data using a pre-designed extraction tool. We used thematic summaries to condense our findings and mapped patterns that we observed. To analyze experiences and recommendations for improved EmOC assessments, we took a deductive approach for the framework synthesis. RESULTS: Twenty-seven studies met our inclusion criteria, with 17 judged as high quality. The highest publication frequency was observed in 2015. Most assessments were conducted in Nigeria and Tanzania (four studies each) and Bangladesh and Ghana (three each). Most studies (17) were done at subnational levels with 23 studies using the 'handbook' alone, whereas the others combined the 'handbook' with other frameworks. Seventeen studies conducted facility-based surveys, whereas others used mixed methods. For different reasons, intrapartum and very early neonatal death rate and proportion of deaths due to indirect causes in EmOC facilities were the least reported indicators. Key emerging themes indicate that data quality for EmOC assessments can be improved, indicators should be refined, a holistic approach is required for EmOC assessments, and assessments should be conducted as routine processes. CONCLUSIONS: There is clear justification to review how EmOC assessments are being conducted. Synergy between researchers, EmOC program managers, and other key stakeholders would be critical for improved assessments, which would contribute to increased accountability and ultimately service provision

Travel of pregnant women in emergency situations to hospital and maternal mortality in Lagos, Nigeria: a retrospective cohort study

Introduction: Prompt access to emergency obstetric care (EmOC) reduces the risk of maternal mortality. We assessed institutional maternal mortality by distance and travel time for pregnant women with obstetric emergencies in Lagos State, Nigeria. Methods: We conducted a facility-based retrospective cohort study across 24 public hospitals in Lagos. Reviewing case notes of the pregnant women presenting between 1st November 2018 and 30th October 2019, we extracted socio-demographic, travel, and obstetric data. The extracted travel data was exported to Google Maps, where driving distance and travel time data were extracted. Multivariable logistic regression was conducted to determine the relative influence of distance and travel time on maternal death. Findings: Of 4,181 pregnant women with obstetric emergencies, 182 (4·4%) resulted in maternal deaths. Among those who died, 60.3% travelled ≤10km directly from home, and 61·9% arrived at the hospital ≤30mins. The median distance and travel time to EmOC was 7·6km (IQR 3·4-18·0) and 26mins (IQR 12- 50). For all women, travelling 10-15km (2·53, 95%CI 1·27-5·03) was significantly associated with maternal death. Stratified by referral, odds remained statistically significant for those travelling 10-15km in the non-referred group (2·48, 95%CI 1·18-5·23) and for travel ≥120min (7.05, 95%CI 1.10-45.32). For those referred, odds became statistically significant at 25-35km (21·40, 95%CI 1·24-36·72) and for journeys requiring travel time from as little as 10-29min (184.23, 95%CI 5.14-608.51). Odds were also significantly higher for women travelling to hospitals in suburban (3·60, 95%CI 1·59–8·18) or rural (2·51, 95%CI 1·01–6·29) areas. Conclusion: Our evidence shows that distance and travel time influence maternal mortality differently for referred women and those who are not. Larger scale research that uses closer-to-reality travel time and distance estimates as we have done, rethinking of global guidelines, and bold actions addressing access gaps, including within the suburbs, will be critical in reducing maternal mortality by 2030

Proceedings of the 39th Annual Scientific Conference of The Association of Public Health Physicians of Nigeria

No Abstract